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Traumatic Brain Injury: Persistent Misconceptions and Knowledge Gaps Among Educators

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Abstract

Each year approximately 700,000 U.S. children aged 0-19 years sustain a traumatic brain injury (TBI) placing them at risk for academic, cognitive, and behavioural challenges. Although TBI has been a special education disability category for 25 years, prevalence studies show that of the 145,000 students each year who sustain long-term injury from TBI, less than 18% are identified for special education services. With few students with TBI identified for special education, TBI is mistakenly viewed as a low-incidence disability, and is covered minimally in educator preparation. We surveyed educators and found that they lacked knowledge, applied skills, and self-efficacy in working with students with TBI. While those with special education credentials and/or additional training scored significantly higher than general educators, all demonstrated inadequate skills in working with students with TBI. This finding suggests that teachers, especially those in general education, have misconceptions and knowledge gaps about TBI and its effects on students. Misconceptions have led to the misidentification and under-identification of students with TBI, leaving this group of students with disabilities potentially underserved. To meet the academic and behavioural needs of students with TBI, all educators need effective training in working with students with TBI.
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Traumatic Brain Injury: Persistent Misconceptions
and Knowledge Gaps Among Educators
Deborah E'el, PhD, NCSP
Eugene School District 4J5'&6&#789:;<#=>&<&8$
Ann E. Glang PhD
Center on Brain Injury Research & Training5'=?#=>?9$"/&?"><&8$
Bonnie Todis
Center on Brain Injury Research and Training5'@">>1&09$"/&?"><&8$
Susan C. Davies
University of Dayton5',8=A1&,-9$8=B0"><&8$
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Exceptionality Education International
2016, Vol. 26, No. 1, pp. 1–18
ISSN 1918-5227 1
Traumatic Brain Injury: Persistent Misconceptions and
Knowledge Gaps Among Educators
Deborah Ettel
Eugene School District 4J
Ann E. Glang, Bonnie Todis
University of Oregon
Susan C. Davies
University of Dayton
Abstract
Each year approximately 700,000 U.S. children aged 019 years sustain a
traumatic brain injury (TBI) placing them at risk for academic, cognitive,
and behavioural challenges. Although TBI has been a special education
disability category for 25 years, prevalence studies show that of the
145,000 students each year who sustain long-term injury from TBI, less
than 18% are identified for special education services. With few students
with TBI identified for special education, TBI is mistakenly viewed as a
low-incidence disability, and is covered minimally in educator preparation.
We surveyed educators and found that they lacked knowledge, applied
skills, and self-efficacy in working with students with TBI. While those with
special education credentials and/or additional training scored
significantly higher than general educators, all demonstrated inadequate
skills in working with students with TBI. This finding suggests that
teachers, especially those in general education, have misconceptions and
knowledge gaps about TBI and its effects on students. Misconceptions have
led to the misidentification and under-identification of students with TBI,
leaving this group of students with disabilities potentially underserved. To
meet the academic and behavioural needs of students with TBI, all
educators need effective training in working with students with TBI.
Ettel, Glang, Todis, & Davies
2 Exceptionality Education International, 2016, Vol. 26, No. 1
Each year approximately 700,000 U.S. children aged 0–19 years sustain a traumatic brain
injury (TBI) requiring hospitalization or emergency treatment (Faul, Xu, Wald, &
Coronado, 2010). Children with TBI are at risk for a range of challenges that impair
academic performance and their transition to post-secondary education and employment
(Anderson, Catroppa, Morse, Haritou, & Rosenfeld, 2009; Beauchamp et al., 2011;
Catroppa & Anderson, 2007; Chapman et al., 2010; Ganesalingam et al., 2011; Gerrard-
Morris et al., 2010; Kurowski et al., 2011; Yeates et al., 2005). Children with moderate to
severe injuries are likely to have cognitive, behavioural, and social difficulties that affect
their long-term quality of life (Rivara, Vavilala, et al., 2012). Even mild injuries to the
developing brain (i.e., concussion) can result in persistent neural alterations (Eisenberg,
Andrea, Meehan, & Mannix, 2013; Rivara, Koepsell, et al., 2012; Walz, Cecil, Wade, &
Michaud, 2008) that significantly affect social and educational functioning (Sesma,
Slomine, Ding, McCarthy, & the Children’s Health After Trauma Study Group, 2008).
Effects of TBI on School Performance
Although students with TBI share some characteristics with students with other
disabilities, the unpredictable mix of cognitive, behavioural, and social impairments
associated with TBI are unfamiliar to most teachers (Glang et al., 2015). Inconsistent
learning profiles, knowledge gaps, and lack of self-awareness pose particular challenges
in the classroom setting (Farmer, Clippard, & Luehr-Wiemann, 1996; Farmer & Johnson-
Gerard, 1997; Glang, Sohlberg, & Todis, 1999; Telzrow, 1987; Ylvisaker & Feeney,
1998). Impairment of executive functioning, attention, concentration, and processing
speed following TBI also contribute to academic difficulties (Halstead et al., 2013;
Iverson, Brooks, Collins, & Lovell, 2006; Moser, Schatz, & Jordan, 2005); and up to a
third of students with TBI also develop behavioural or psychological symptoms (Barlow
et al., 2010; Rimel, Giordani, Barth, Boll, & Jane, 1981; Willer & Leddy, 2006; Yeates,
2010). Because many teachers are unaware of the effects TBI can have on behaviour,
behaviour problems are often misdiagnosed as premorbid rather than being appropriately
linked to the TBI (Clark, Russman, & Orme, 1999).
TBI at any point during childhood can disrupt normative development, contributing
to subsequent deficits in performing age-appropriate functions. Children who sustain
injuries in infancy and early childhood often have significant skill deficits and poor long-
term outcomes that might not be recognized as consequences of their injury. Although
students injured in adolescence often recover many of the academic skills and knowledge
acquired before the injury, they are likely to have difficulty learning new material and
developing higher order reasoning, organizational, and social skills (Anderson &
Catroppa, 2005; Anderson, Catroppa, Morse, Haritou, & Rosenfeld, 2005).
TBI Identification Rates
Of the 700,000 yearly childhood (ages 0–19) TBIs that require hospitalization,
prevalence studies (Zaloshnja, Miller, Langlois, & Selassie, 2008) report that
approximately 145,000 cases result in a long-term or lifelong TBI-related disability. The
number of students enrolled in the TBI category of special education is 26,000 (U.S.
Department of Education National Center for Education Statistics, 2015), indicating that
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 3
fewer than 18% of students who likely need services are receiving them. Special
education identification rarely occurs after the first year post-injury, so children with
early injuries or emerging problems are unlikely to be identified (Taylor et al., 2003).
When academic and behaviour problems become evident years later, they are likely to be
linked to specific learning disability (SLD) or behaviour disorders, rather than TBI. In a
recent survey, most state special education directors reported that students with TBI are
not appropriately identified in their states, and fewer reported a TBI specialist within the
state education agency than in 1999 (Glang, Todis, Ettel, & Yeates, 2013).
Misidentification of TBI as another disability can contribute to incomplete or
inappropriate assessment and resultant support services. Unlike some other disabilities,
the recovery process for students with TBI is often dynamic, requiring frequent
monitoring and program adjustment; some sequelae may not fully appear until long after
the injury is forgotten. The student with TBI may have underlying vision, sensory, gait,
mood, or fatigue issues that may go unaddressed because of misidentification or lack of
awareness. Further, the social-emotional needs of a student (and family) recovering from
brain injury are typically very different from those of a student with a lifelong learning
disability. Unlike most disabilities, with TBI there is a “before” and “after.” Consider the
differences between a once high-achieving, socially adept student whose post-TBI status
is suddenly significantly impaired and the student with a longstanding learning or
behaviour disorder. While under-identification of TBI clearly has costs, so, too, does
misidentification (Dyches & Prater, 2010).
Failure to provide appropriate educational services to students with TBI could be due
in part to lack of teacher knowledge and skills (Todis & Glang, 2008; Todis, Glang,
Bullis, Ettel, & Hood, 2011). Surveys of speech-language pathologists (Evans, Hux,
Chleboun, Goeken, & Deuel-Schram, 2009), school psychologists (Hooper, 2006), and
teachers (Davies, Fox, Glang, Ettel, & Thomas, 2013) reveal limited training in
assessment and intervention with TBI, suggesting inadequate preparation across
professions. A recent survey of teachers in the United Kingdom also demonstrated this
lack of preparation, and suggested that teachers hold misconceptions about TBI, which
may adversely affect the child’s school experience (Linden, Braiden, & Miller, 2013). A
recent survey of state directors of special education showed that state leaders believe their
annual TBI student counts are inaccurate; more than a quarter of those indicate that the
inaccuracy was significant (Glang et al., 2015). One of the main reasons given for that
inaccuracy was lack of teacher awareness about TBI as a disability (e.g., teachers not
understanding the long-term consequences of TBI and parents’ and professionals’
unfamiliarity with the characteristics of students with brain injury, the definitions used by
schools, and the consequences of injury on school performance). Another reason state
directors gave for the inaccuracy was misidentification of students with TBI. State
directors reported that in only 40% of cases were students with TBI identified under the
category of TBI; students with TBI were more often identified under the categories of
SLD, other health impairment, emotional disturbance, and others, or not identified at all
(Glang et al., 2015).
Furthermore, a recent analysis of ten university textbooks revealed that TBI is
minimally discussed in current special education texts (Ettel, McCart, & Glang, 2014). Of
the approximately 500 pages in each text, only an average of 9.8 pages contained
Ettel, Glang, Todis, & Davies
4 Exceptionality Education International, 2016, Vol. 26, No. 1
information about TBI. Only one of the top ten most widely used special education texts
(Turnbull, Turnbull, Wehmeyer, & Shogren, 2013) devoted a chapter specifically to TBI,
although in the United States TBI has been an Individuals with Disabilities Education Act
(IDEA) disability category since 1990. All ten books had a specific chapter on autism
spectrum disorder, and several included a chapter on attention deficit-hyperactivity
disorder, which is not a disability category. Thus, the limited coverage of TBI in teacher
preparation texts supports state special education directors’ perception that educators lack
awareness of TBI—the core texts on disabilities only minimally address TBI compared to
other disability categories.
The purpose of the present study was to assess educator knowledge, skills, and self-
efficacy related to TBI in a sample of teachers currently working in public schools.
The study’s research questions were:
1. What are the current levels of teacher knowledge and skill application in working
with students with TBI?
2. How do teachers rate their ability to work effectively with students with TBI
(self-efficacy)?
3. Which teacher characteristics predict knowledge, skills, and self-efficacy in
working with students with TBI?
Methods
Participants
We recruited participants through print and online advertising on LDOnline, a
website that targets general and special education teachers working with students with
learning disabilities. Potential participants accessed an online screening tool by clicking a
link on the website. A total of 352 teachers participated in the survey. Most of the teachers
were from the United States (82%), were special education teachers (62%), and had
obtained a master’s degree or greater (75%). Respondents included preschool through high
school teachers, and the sample was evenly distributed across the grades. Twenty-five
percent of the sample indicated they had taught for 26 or more years. About one third had
taught for 110 years, and another third had taught for 1125 years. In addition, about one
third of the respondents (33%) indicated that they had worked with 15 students with TBI,
and more than half (55%) indicated that they had previously worked with 610 students
with TBI. Only about one quarter of the teachers said that they had prior training in
working with students with TBI, but almost all said that they had worked with at least one
student with TBI (85% worked with 110 students with TBI).
Instruments
TBI knowledge. The TBI Knowledge Survey was adapted from a validated
instrument (Hux, Bush, Evans, & Simanek, 2013; Hux, Walker, & Sanger, 1996), with
additional items derived from TBI training materials (Dise-Lewis, Lewis, & Reichardt,
2009; Glang, Tyler, Pearson, Todis, & Morvant, 2004). The final 30-item adapted version
for the current study (see Appendix) included a four-point response option (true,
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 5
probably true, probably false, and false). For scoring, responses were combined to form
two categories, true–probably true and false–probably false. The number of correct items
was summed and a percentage correct computed.
TBI skill application and self-efficacy. TBI skill application—knowledge
application—was assessed with four scenarios depicting classroom situations involving
students with TBI. Each scenario was assessed with a six-point scale (would never
respond this way, fairly unlikely, not very likely, somewhat likely, fairly likely, and very
likely to respond this way). The responses fairly likely to respond this way and very likely
to respond this way were combined and scored as correct in response to the correctly
handled scenarios. Likewise, the responses fairly unlikely to respond this way and would
never respond this way were combined and scored as correct in response to the
incorrectly handled scenarios. A total score of number of correct responses was
computed. Because self-efficacy is theoretically linked to behaviour change (Ajzen,
1991; Ajzen, Joyce, Sheikh, & Gilbert Cote, 2011), survey items also assessed this
construct with the same four scenarios (e.g., “How confident are you that you could
successfully handle a situation like this?”) using a six-point scale (1 = not at all
confident, 6 = completely confident; alpha = .82).
A copy of the teacher survey appears in the Appendix.
Procedures
The evaluation was conducted over Survey Console, a secure server on the Internet.
When potential participants accessed the link provided in the study advertisements, they were
taken directly to the survey and given a unique identifier access number. For participating in
the study, participants were offered a chance to win one of five $200 cash awards.
Data Analysis
We used independent t-tests and one-way ANOVA models with Scheffé follow-up
tests to examine whether TBI knowledge, skill application, and self-efficacy differed by
the following teacher characteristics: (a) current area of teaching, (b) special education
license held, (c) history of TBI training, (d) years of teaching experience, and (e) number
of students with TBI worked with in a school setting. We provide Cohen’s d-statistic
(Cohen, 1988) as a measure of effect size following the convention of d=.2, small; d= .5,
medium; and d= .8, large effects.
Results
The average TBI knowledge score across all teachers was 55.9 % (SD = 9.8, range
26.6–80.0). Three statistically significant differences in TBI knowledge scores by teacher
characteristics appeared. Special education teachers had significantly higher knowledge
scores than general education teachers (56.8 vs. 54.3), a moderately small effect (d =
.25); teachers with a history of TBI training had significantly higher knowledge scores
than teachers without training (58.4 vs. 55.1), a moderately small effect (d = .34); and
years of teaching experience was significantly related to knowledge scores, a moderately
Ettel, Glang, Todis, & Davies
6 Exceptionality Education International, 2016, Vol. 26, No. 1
small effect (d = .37). Follow-up Scheffé contrasts found no categories of years of
teaching that statistically differed at p < .05.
The average TBI skill application score across all teachers was 72 % (8.6/12 [SD =
2.1, range 0–12]). We found two statistically significant differences in TBI skill
application scores by teacher characteristics (Table 1). Special education teachers had
significantly higher TBI skill application scores than general education teachers (8.9 vs.
8.3), a moderately small effect (d = .31), and teachers who held a special education
license had significantly higher TBI skill application scores than those who did not have a
license (8.8 vs. 8.3), a small effect (d = .24).
Table 1
TBI Applied Skills Scores by Teacher Characteristics
The average TBI self-efficacy score across all teachers was 4.8 on a scale of 06 (SD
= 0.7, range 1.56.0). We found three statistically significant differences in self-efficacy
score by teacher characteristic (Table 2). Special education teachers had significantly
higher self-efficacy scores than general education teachers (4.9 vs. 4.6), a moderately small
effect (d = .41); teachers who held a special education license had significantly higher self-
efficacy scores than those who did not have a license (4.8 vs. 4.6), a moderately small
effect (d = .37); and the number of TBI students taught was significantly related to self-
efficacy scores, a moderately small effect (d = .36). Follow-up Scheffé contrasts found that
teachers who had never taught a student with TBI had significantly lower scores than
teachers who had taught more than 10 students with TBI (4.6 vs. 5.1).
Mean
SD
Test Statistic
p-value
Current area of teaching
t(349) = 2.80
.006
General education
8.25
2.12
Special education
8.88
1.99
History of TBI training
t(350) = 0.57
.566
No
8.61
2.13
Yes
8.76
1.91
Years of teaching experience
F(5,346) = 0.86
.507
0–5 years
8.41
1.91
6–10 years
8.62
1.99
1115 years
9.11
2.04
1620 years
8.48
1.89
2125 years
8.68
2.46
26 or more years
8.51
2.06
No. of TBI students
F(3,347) = 0.50
.680
0
8.52
2.26
1–5
8.73
1.96
6–10
8.36
2.26
More than 10
8.93
1.79
TBI = traumatic brain injury, SD = standard deviation, Effect size = Cohen’s d-statistic
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 7
Table 2
TBI Self-Efficacy Scores by Teacher Characteristics
Mean
SD
Test Statistic
p-value
Effect size
Current area of teaching
t(348) = 3.73
<.001
.41
General education
4.59
0.69
Special education
4.85
0.63
SPED license held
t(349) = 3.21
.001
.37
No
4.59
0.69
Yes
4.83
0.64
History of TBI training
t(349) = 1.46
.082
.18
No
4.72
0.66
Yes
4.84
0.67
Years of teaching experience
F(5,345) = 0.33
.895
.14
0–5 years
4.82
0.68
6–10 years
4.69
0.59
1115 years
4.80
0.65
1620 years
4.70
0.68
2125 years
4.73
0.64
26 or more years
4.77
0.73
No. of TBI students
F(3,346) = 3.78
.011
.36
0
4.61
0.73
1–5
4.80
0.62
6–10
4.78
0.57
More than 10
5.11
0.76
SPED = special education, TBI = traumatic brain injury, SD = standard deviation, Effect size = Cohen’s d-
statistic
Discussion
The results of this survey suggest that during the 25 years since TBI became a
disability category under IDEA (“Individuals with Disabilities Education Act,” 1990),
teacher preparedness to work with students with TBI has not changed significantly.
Although special education teachers in our sample scored significantly higher than
general education teachers on knowledge of TBI, the knowledge scores for both groups
were below 60 %. If a minimum criterion for competence is 70 % correct—a C grade—
teachers (both general education and special education) earned an F. Hooper (2006)
reported similar rates of knowledge about TBI among school psychologists in two states
and in a sample of special education teachers in several states. In Hux’s (1996) study,
20% of special education teachers were unaware that TBI was even an eligibility
category for services (Glang et al., 2008).
In applied skills, teachers fared better, with an average of 72% on application of
appropriate instruction and intervention. However, it could be that on this skills measure,
despite a lack of specific TBI training, teachers applied their skills in working with all
students with disabilities or learning challenges to the scenarios.
Ettel, Glang, Todis, & Davies
8 Exceptionality Education International, 2016, Vol. 26, No. 1
We also found that greater knowledge of TBI is associated with years of teaching
experience and that working with 10 or more students with TBI across a teaching career
increased the ratings of self-efficacy. But the only significant difference was between
those who had never taught a student with TBI and those who had taught 10 or more, and
neither case is typical. Although it is logical that knowledge and self-efficacy would
improve with hands-on experience over the years, trial-and-error is not the most efficient
path for teachers to gain expertise with students with TBI. They—and the students they
serve—deserve competent support.
Teachers with more training demonstrated greater knowledge and applied skills and
reported greater self-efficacy than teachers with less training. This finding echoes the
recent assertion by state directors of special education that teachers’ lack of awareness of
TBI is a main cause of inaccurate identification of students with TBI, a finding further
reinforced by the limited coverage of TBI as a disability in teacher preparation textbooks.
Training in special education was associated with increased levels of knowledge,
TBI skills, and self-efficacy in working with students with TBI. However, since most
students with TBI are not identified for special education (U.S. Department of Education
National Center for Education Statistics, 2015; Zaloshnja et al., 2008), they are in many
cases served by teachers who are unprepared to work effectively with them. This finding
suggests that increased rates of special education identification among students with TBI
would provide them with the best opportunity to work with teachers who are at least
somewhat prepared to meet their specific needs
Increasing TBI training for all teachers might also address the issue of
misidentification of students with TBI under alternate eligibility categories.
Misidentification contributes to under-identification, leading to a misperception that TBI
is a low-incidence disability that few teachers will encounter in their classrooms. This
misperception in turn leads districts and states, as well as teacher preparation programs,
to underestimate the need for training and research in TBI. Accurate identification would
increase the visibility of students with TBI and increase the likelihood that those students
would receive appropriate support services. Accurate identification will not be possible,
however, without increased teacher knowledge and skills in TBI. Increased awareness of
TBI is the key to correcting the downward spiral that characterizes current educational
practices for students with TBI.
Limitations
The survey participants represent a convenience sample, a nonprobability sample
with inherent biases. While cost effective, this nonrandom sampling method leaves
doubts about the extent to which results may be generalized to the larger population.
Further, the use of a closed (as opposed to an open-ended) response system of
measurement in our scenario questions may have inaccurately captured the extent of
teacher knowledge.
In this study, teacher ratings of self-efficacy served as a proxy for their skill in meeting
the needs of students with TBI. Teachers with higher self-efficacy have been found to show
more support and provide a more positive classroom environment than those with lower
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 9
self-efficacy, and their students showed stronger literacy skills (Guo, Connor, Yang,
Roehrig, & Morrison, 2012). Observational studies comparing delivery of services by
trained and untrained teachers would provide a more accurate assessment of teacher skill in
instruction and behaviour management. However, because the ultimate goal of assessing
teacher preparedness is to gauge teachers’ ability to effect positive student change, a
randomized study comparing student outcomes under different teaching conditions would
provide the most accurate assessment of the effects of different levels of teacher knowledge
and awareness on teacher behaviour and its effects on students with TBI. But the feasibility
of such a study is limited by ethical, procedural, and financial considerations.
Conclusion
The goal of special education is to provide services to students that make it possible
for them to achieve their full potential. Achieving that goal requires teachers who have
the awareness, knowledge, and skills to work effectively with each student, regardless of
disability condition. Currently, many students with TBI do not have access to special
education services, which suggests not only that assessment and identification practices
should be improved, but also that both general and special education teachers need to be
prepared to work with this population.
This survey suggests that teachers, especially those in general education, have some
basic misconceptions and knowledge gaps about TBI and the effects of brain injury on
students in their classrooms, the consequences of which are not minor. Misconceptions
have led to the misidentification and under-identification of students with TBI for special
education, leaving this group of students with disabilities potentially mis-served and
underserved. To meet the academic and behavioural needs of students with TBI, all
teachers need effective training, pre-service and in-service, in methods that have been
validated with students with TBI and in adapting strategies validated with students with
other disabilities to students with TBI (Dettmer, Ettel, Glang, & McAvoy, 2014; Glang,
Todis, Sublette, Eagan-Brown, & Vaccaro, 2010; Ylvisaker et al., 2005; Ylvisaker et al.,
2001). That was the expectation and promise of IDEA in 1990 when TBI became a
disability category.
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Authors’ Note
Correspondence concerning this article should be addressed to Deborah Ettel, 2750 Capital Drive,
Eugene, OR, 97403, USA. Email: drdeb2009@gmail.com
!
Appendix
!
TBI$Knowledge$Survey$!
$
$
Your$Current$Area$of$Teaching:$
!!!"#$#%&'!()*+&,-.$!!!!/0#+-&'!()*+&,-.$!
!
$
Current$Grade(s)$Taught$(select$all$that$apply):$
1%#2+3..'!!!4!!!5!!!6!!!7!!!8!!!9!!!:!!!;!!!<!!!=!!!5>!!!55!!!56!
!
$
Highest$Degree$Earned:$
!! !?&+3#'.%@2!!A&2,#%@2!!B.+,.%&,#!
!
$
Date$Highest$Earned:$
!!?#C.%#!5=;>!!!!5=;>D<>!!!!5=<5D=>!!!5==5D6>>>!!!!6>>5D6>5>!
!
$
Areas$of$certification(s)/license(s)$held:$
!!!"#$#%&'!()*+&,-.$!!!/0#+-&'!()*+&,-.$!
!
$
Were$you$trained$or$are$you$being$trained$in$traumatic$brain$injury$(TBI)?$$$
!!!E(/!!!FG!
!
$
!$
Ettel, Glang, Todis, & Davies
14 Exceptionality Education International, 2016, Vol. 26, No. 1
If$YES,$describe$what$kind$of$training$you$have$received$[check$all$that$apply]:$$
!!Class/seminar!specifically!devoted!to!TBI?!!
!!Survey!class!on!disabilities?!
!!Workshop!(halfDday!or!more)?!
!!InDservice/professional!development!seminar?!
!
$
Other$Training$(if$applicable)$
! !_____________________________________________________________________!!
!
$
Please$list$any$TBI$resources$that$were$used$in$your$training$(e.g.,$websites,$books,$training$
manuals,$etc.):$
! !_____________________________________________________________________!!
$
!
Teaching!Experience!
!
$
Years$of$teaching$experience:$$
!!0D5! !6D10!!11D15!!16D20!!21D25!!26+!
!
$
Approximately$how$many$students$with$TBI$have$you$worked$with$in$a$school$setting?$$$$
!!none!(0)!!few!(1D5)!!several!(6D10)!!many!(>11)!
$
$
Personal!Experience!
!
$
Do$you$have$a$close$friend$or$family$member$who$has$ever$sustained$a:$
! ! !YES! !NO!
!Concussion/mild!brain!injury!!!!!
!ModerateD!severe!brain!injury!!!
!
$
Have$you$ever$sustained$a:$
! ! !YES! !NO!
!Concussion/mild!brain!injury!!!!!
!ModerateD!severe!brain!injury!!!
!
$
! !
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 15
Section!1!
Please$mark$True,$Probably$True,$Probably$False,$or$False$
$
!
!
True!
Probably!
True!
Probably!
False!
False!
1.!
TBI!is!equally!common!in!males!and!females.!
!
!
!
!
2.!
A!child/adolescent!in!a!coma!is!usually!not!aware!of!
what!is!happening!around!!!them.!!
!
!
!
!
3.!
After!a!brain!injury,!children/adolescents!can!forget!who!
they!are!and!not!recognize!others,!but!be!‘normal’!in!
every!other!way.!!
!
!
!
!
4.!
A!brain!injury!affects!girls’!and!boys’!brains!differently.!!
!
!
!
!
5.!
Even!after!several!weeks!in!a!coma,!when!
children/adolescents!wake!up,!most!recognize!and!
speak!to!others!right!away.!!
!
!
!
!
6.!
After!a!brain!injury,!it!is!usually!harder!to!learn!new!things!
than!it!is!to!remember!things!from!before!the!injury.!!
!
!
!
!
7.!
A!child/adolescents!’s!preDinjury!status!(i.e.,!intellectual!
and!emotional!functioning)!is!likely!to!impact!recovery!
from!brain!injury.!!
!
!
!
!
8.!
Children/adolescents!who!have!had!one!brain!injury!are!
more!likely!to!have!a!second!one.!!
!
!
!
!
9.!
Complete!recovery!from!severe!brain!injury!is!not!
possible!no!matter!how!badly!the!child/adolescent!
wants!to!recover.!!
!
!
!
!
10.!
Children/adolescents!are!likely!to!recover!more!
completely!from!a!brain!injury!than!adults!due!to!the!
greater!plasticity!of!the!young!brain.!!
!
!
!
!
11.!
A!child!who!acquires!a!brain!injury!between!12!and!16!
will!typically!present!an!even!pattern!of!academic!
strengths!and!weaknesses.!!
!
!
!
!
12.!
A!child’s!brain,!unlike!an!adult’s,!is!able!to!“bounce!
back”!after!a!brain!injury.!!
!
!
!
!
13.!
It!is!common!for!children/adolescents!with!brain!injuries!
to!be!easily!angered.!!
!
!
!
!
14.!
Fluctuation!among!cognitive!abilities!is!a!finding!typical!
of!children!and!adolescents!who!have!a!brain!injury,!and!
not!typical!of!the!general!population!of!children!and!
adolescents.!!
!
!
!
!
15.!
When!children/adolescents!are!knocked!unconscious,!
most!wake!up!quickly!with!no!lasting!effects.!!
!
!
!
!
! !
Ettel, Glang, Todis, & Davies
16 Exceptionality Education International, 2016, Vol. 26, No. 1
Section!1,!continued!
Please$mark$True,$Probably$True,$Probably$False,$or$False$
$
!
!
True!
Probably!
True!
Probably!
False!
False!
16.!
It!is!important!to!provide!many!details!when!delivering!
instructions!to!a!student!with!brain!injury.!!
!
!
!
!
17.!
Greater!variability!exists!in!the!population!of!students!
with!TBI!than!exists!in!populations!of!other!students!
with!disabilities.!!
!
!
!
!
18.!
The!only!sure!way!to!tell!if!someone!has!suffered!brain!
impairment!from!a!brain!injury!is!by!an!XDray!of!the!brain.!!
!
!
!
!
19.!
Knowing!the!location!of!brain!injury!resulting!from!TBI!
helps!in!the!development!of!programming!to!meet!a!
student’s!needs.!
!
!
!
!
20.!
Many!students!with!TBI!display!characteristics!similar!to!
those!of!students!with!a!learning!disability.!!
!
!
!
!
21.!
Knowledge!of!a!student’s!background!prior!to!TBI!is!
necessary!when!developing!an!educational!plan.!!
!
!
!
!
22.!
Medical!labels!that!specify!TBI!as!mild,!moderate,!or!
severe!are!useful!for!programming!communication!and!
academic!services.!!
!
!
!
!
23.!
The!primary!goal!of!brain!injury!rehabilitation!is!to!
increase!physical!abilities!such!as!walking.!!
!
!
!
!
24.!
Many!students!with!TBI!perform!better!in!structured!
testing!situations!than!they!do!in!classroom!settings.!!
!
!
!
!
25.!
The!challenges!of!students!with!TBI!are!typically!more!
difficult!to!assess!than!the!challenges!of!students!with!
other!disabilities.!!
!
!
!
!
26.!
Most!special!and!regular!educators!are!knowledgeable!
about!the!speech,!language,!and!cognitive!
communication!problems!associated!with!TBI.!!
!
!
!
!
27.!
Students!with!TBI!often!have!trouble!forming!and!
maintaining!friendships.!
!
!
!
!
28.!
Recovery!following!TBI!may!continue!for!several!years.!!
!
!
!
!
29.!
Students!with!TBI!often!display!behavior!problems.!!
!
!
!
!
30.!
Standardized!tests!are!more!beneficial!than!descriptive!
measures!(e.g.,!language!samples,!interviews,!checklists,!
observations)!in!assessing!cognitive!deficits!secondary!
to!TBI.!
!
!
!
!
! !
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 17
Section!2!
!"#$%&'("&)$*(&+,))"("-.&/0"-'(,$/&1$*&2,34.&"-0$*-."(&,-&.4"&0#'//($$25&6$(&"'04&/0"-'(,$7&0$-/,+"(&
.4'.&.4"&04,#+&,-&8*"/.,$-&4'/&9:;<=<>?;>@A&/4$%-&.4"&+"/0(,B"+&B"4'C,$(&'-+&,.&,/&;:>&'-&,/$#'."+&
"C"-.5&>4"&04,#+&2'1&4'C"&B""-&,+"-.,),"+&'/&4'C,-3&4'+&'&.('*2'.,0&B(',-&,-D*(1&E>!=F&$(&1$*&/*/G"0.&
.4'.&4"H/4"&2'1&4'C"&4'+&'&>!=5&I#"'/"&('."&4$%&#,J"#1&1$*&'("&.$&("/G$-+&,-&"'04&G$//,B#"&("/G$-/"5&
<0$("&?K9L&("/G$-/"&B1&4$%&#,J"#1&1$*&%$*#+&B"&.$&"2G#$1&"'04&'0.,$-&,-&.4"&/,.*'.,$-&+"/0(,B"+5&
MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM&
1)$Susan$has$difficulty$paying$attention$in$her$3rd$grade$class,$especially$in$the$afternoon.$She$
is$often$caught$daydreaming$or$is$otherwise$distracted$but$not$disruptive.$She$sometimes$
complains$of$headaches.$You$could:$
'5&
N"G$/,.,$-&4"(&+"/J&.$&)($-.&$)&($$2&/$&1$*&0'-&J""G&'-&"1"&$-&4"(&'-+&2',-.',-&4"(&'.."-.,$-5&&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
&
B5&<"-+&'&-$."&4$2"&.$&4"(&G'("-./&0'*.,$-,-3&'B$*.&.4"&0$-/"8*"-0"/&$)&0$-.,-*"+&G($B#"2&
B"4'C,$(5&&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
&
05&9$-/,+"(&(")"((,-3&4"(&)$(&KQLQ&."/.,-35&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
&
$
+5&L$%&0$-),+"-.&'("&1$*&.4'.&1$*&0$*#+&/*00"//)*##1&4'-+#"&'&/,.*'.,$-&#,J"&.4,/R$
&;$.&'.&'##&&P"(1&@,..#"&&<$2"%4'.&P"(1&9$-),+"-.&9$2G#"."#1&9$-),+"-.&
&
MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM&
2)$All$through$middle$school$and$now$in$9th$grade,$Dave$rarely$hands$in$assignments$on$time,$
seldom$gets$to$class$before$the$bell$rings$and$inevitably$forgets$to$bring$books$or$pencil$to$
class.$He$has$the$ability$to$do$average$work$but$has$problems$initiating$tasks.$You$could:$
'5&>'J"&Q'C"S/&-$."B$$J&'-+&*/"&'&/"(,"/&$)&-$."/&#'2,-'."+&,-&.4"&-$."B$$J&.$&$*.#,-"&.4"&
/."G/&("8*,("+&)$(&1$*(&0#'//5&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
&
B5&<'1T&UA$*S("&,-&V.4&3('+"&-$%5&W'J"&/*("&1$*&0$2"&G("G'("+&)$(&0#'//&$(&1$*&2'1&"-+&*G&,-&
/*22"(&/04$$#5X&$(&/,2,#'(&%'(-,-3&$)&.4"&0$-/"8*"-0"/&$)&0$-.,-*"+&+,/$(3'-,Y'.,$-5&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
&
05&9$-)"("-0"&%,.4&Q'C"&'-+&4,/&G'("-./&.$&/.('."3,Y"&4$%&Q'C"&0'-&3".&.$&0#'//&$-&.,2"&'-+&B"&
G("G'("+&.$&G'(.,0,G'."&-$%&.4'.&4"&,/&,-&4,34&/04$$#5&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
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$
+5&How$confident$are$you$that$you$could$successfully$handle$a$situation$like$this?$
&;$.&'.&'##&&P"(1&@,..#"&&<$2"%4'.&P"(1&9$-),+"-.&9$2G#"."#1&9$-),+"-.&
&
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Ettel, Glang, Todis, & Davies
18 Exceptionality Education International, 2016, Vol. 26, No. 1
Section!2,!continued!
!
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD!
3)$Mary$hits,$shoves,$or$pushes$peers$and/or$adults$in$her$8th$grade$classes$with$little$or$no$
provocation,$and$uses$aggressive$or$threatening$language.$You$could:$
a.!Teach!Mary!strategies!for!identifying!impending!anger!or!frustration!and!allow!her!to!take!inD
class!timeDouts.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
b.!Establish!and!explain!clear!rules!for!expected!behavior!and!natural!or!logical!consequences!if!
the!rules!are!not!followed!and!consistently!follow!up!on!established!consequences.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
c.!Identify!any!“triggers”!that!seem!to!precede!the!aggressive!behaviors!and!manage!the!
environment!to!reduce!those!triggers.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
$
d.!How$confident$are$you$that$you$could$successfully$handle$a$situation$like$this?!
!Not!at!all!!Very!Little!!Somewhat!Very!Confident!Completely!Confident!
!
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD!
4)$Phillip$is$in$11th$grade$and$constantly$speaks$out$of$turn,$shows$off,$or$engages$in$other$
apparent$attentionZseeking$behavior.$It$is$often$disruptive$to$classroom$activities.$You$could:$
a.!Instruct!other!students!to!ignore!the!attentionDseeking!behaviors.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
b.!Ensure!that!strategies!are!in!place!to!enhance!Phillip’s!selfDesteem!and!selfDconcept!(such!as!
providing!challenging!and!meaningful!tasks)!so!he!has!less!need!to!act!out.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
c.!Provide!opportunities!for!him!to!work!successfully!with!other!students.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
$
d.!How$confident$are$you$that$you$could$successfully$handle$a$situation$like$this?!
!Not!at!all!!Very!Little!!Somewhat!Very!Confident!Completely!Confident!
!
$
!
!
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... 21 It has been reported that many educators lack opportunities to obtain and gain ABI knowledge, and are underprepared and under-resourced to accommodate the learning needs of students with ABI. [22][23][24][25][26] One reason for this lack of knowledge and resources is that within many areas in Canada, brain injury is not recognized as a category of exceptionality within the school boards. However, even in areas where brain injury is recognized as a category of disability, such as in the United States, teacher's level of preparedness to work with students has not changed significantly in the 25 years since this category was introduced. ...
... However, even in areas where brain injury is recognized as a category of disability, such as in the United States, teacher's level of preparedness to work with students has not changed significantly in the 25 years since this category was introduced. 26 Despite these challenges and the gap in educator training, the results of one systematic review revealed that school reintegration interventions after ABI can improve cognitive, behavioral and socioemotional outcomes for students. Furthermore, focused education for school personnel was found to be imperative for a strong return-to-school plan. ...
Article
Background: When a child sustains an acquired brain injury (ABI), the impact extends to significant environments in their life, including school. Educator knowledge of ABI can influence a child's success with academic and social reintegration. An assessment of educator ABI knowledge was conducted to determine what information they require to support school reintegration. Methods: A mixed-methods approach included a sampling of educators in a needs assessment survey and workshop. The survey determined levels of educator knowledge regarding ABI in the classroom, and the workshop scoped educator views in the development of a user-driven ABI learning program to enrich their expertise. Results: Our sample reported being somewhat knowledgeable about ABI and the impact on students. There were no differences based on respondents' educational role. Teachers reported having minimal and inadequate supports for students following ABI during school transitions, feeling unprepared to assist students during these transitions, and that families also appeared unprepared for school reintegration following ABI. The workshop identified the need for a 2-part educational course. Conclusions: Supportive school environments are essential for the reintegration of students following ABI. This study identified educators' needs for ABI knowledge and resources to support their existing expertise.
... This is an important area of investigation because students with TBI present with a wide variety of symptoms/difficulties, and they need highly tailored supports to aid their learning. Also, these children typically struggle with issues that can span across multiple areas of functioning, including cognitive communication areas, which might affect their performance in all school subjects (Ettel et al., 2016;Popernack et al., 2015). In response to our first research question, we found that on a scale of 0 to 6, the quality scores were average (M = 3.74); however, when compared to goal quality scores from previous investigations, the TBI IEP goals were higher. ...
... This may happen, in part, because the TBI might not be reported (Escobar et al., 2016) or not reported to the appropriate personnel at the time of school entry (Haarbauer-Krupa et al., 2018). It is also possible that teachers do not recognize the symptoms of or attribute these symptoms to TBI, which result in behavioral reports instead of documentation of the challenges subsequent to the TBI (Clark et al., 1999;Ettel et al., 2016). ...
Article
The purpose of this descriptive study was to investigate the quality of Individualized Education Plan (IEP) goals for students with traumatic brain injury (TBI) using an empirically based rating instrument. One hundred twenty-five IEP goals for 49 students with TBI were coded using the Revised IEP/IFSP Goals and Objective Rating Instrument (R-GORI; Notari). Using this dichotomous measure, we analyzed the quality of IEP goals across six areas: observability, measurability, functionality, generalizability, application in daily tasks, and clarity of goals. On average, students had three IEP goals (range: 1–8). The average goal quality score was 3.74 (range: 1–6). While most of the goals were measurable, only a few contained details about how the goals could be generalized beyond the specific educational or therapeutic environment. These findings highlight variability in the quality of IEP goals, which may have implications to the therapeutic environment and child outcomes.
... Regardless of the severity, pediatric TBI can result in brain damage that disrupts typical cognitive growth and development (Crowe et al., 2015;Popernack et al., 2015), which considerably affects academic performance and social interactions (Ettel et al., 2016;Sesma et al., 2008). Common deficits associated with TBI include poor attention, memory, and executive functioning, as well as cognitivelinguistic skills (Aldrich & Obrzut, 2012;Babikian et al., 2015;Slomine & Locascio, 2009). ...
... For example, Clark et al. (1999) found that many teachers attribute behavioral problems subsequent to TBI as premorbid conditions and did not recognize them as a symptom of the TBI sequela. Likewise, teachers do not often attribute deficits of students who sustained a TBI prior to school age to their injury (Ettel et al., 2016). ...
Article
Purpose The purpose of this study was to explore and describe the features of Individualized Education Plans (IEPs) for a cohort of students with traumatic brain injury (TBI) to help elucidate current special education practices for students with TBI. Method We obtained permission from administrators of a local school district of 41,000 students in a Midwestern state to review de-identified IEP records of students verified with TBI. We examined demographic information (i.e., cause and age at time of injury), IEP services and intensity, IEP goal categories, and previous verification status. Results Descriptive results support that intervention services were more intense for students with TBI with greater lengths of time postinjury. Target behaviors within goals were more often related to math and reading than to the cognitive processes that govern these skills, such as attention, memory, and executive functioning. Finally, more than a third of our sample had been verified with a disability and were receiving special education services via an IEP prior to their TBI. Conclusions This work represents an important first step in understanding the special education services for students with TBI. Future research should explore interventions that are ecologically valid for school-based settings and are developed to address the idiosyncratic deficits of students with TBI, particularly interventions that focus on the underlying cognitive processes experienced by these students.
... Once discharged from the hospital, children with TBI usually return to school; however, discrepancies in case counts a between hospitals and schools suggest that these children are not consistently identified or tracked by school service providers (Haarbauer-Krupa et al., 2017;Schutz et al., 2010). Fewer than 18% of students with an identified TBI-related disability were receiving support services in the schools in 2015 (Ettel et al., 2016). The greater the interval between the injury and the onset of academic problems, the lower the likelihood that school personnel will recognize the influence of the prior TBI (Prasad et al., 2017;Taylor et al., 2003), which may partially explain why children who sustain injuries in early childhood show particularly high rates of unmet need for services (Kingery et al., 2017;Salley et al., 2021). ...
Article
Purpose The purpose of this study is to describe and synthesize existing research on nonstandardized assessment of cognitive-communication abilities in children with traumatic brain injury (TBI) in order to improve the detection, diagnosis, and tracking of injury sequelae and guide appropriate service provision. Materials and Method A search of peer-reviewed journal databases revealed 504 unique articles published between January 2000 and August 2019. For full inclusion, articles had to report on empirical studies examining variables related to the nonstandardized assessment of cognitive-communication skills following TBI in children. Review articles, expert opinion pieces, and non–English language articles were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guided this process. Results Results were tabulated for each of the 14 articles that met full inclusion criteria. Included studies presented five different types of nonstandardized assessment: discourse analysis ( n = 3), systematic observation of child's performance during an instrumental activity of daily living ( n = 4), virtual reality tasks ( n = 3), structured cognitive tasks ( n = 2), and functional rating scales ( n = 2). The majority of included studies compared the outcomes of nonstandardized assessment against subtest scores and checklists drawn from a variety of existing standardized and criterion-referenced assessments. Targeted cognitive-communication skills included attention, working memory, self-regulation, planning, multitasking, social problem-solving, inferencing, and macrolevel discourse. Conclusions Preliminary research suggests that a well-designed and systematically implemented nonstandardized assessment can yield essential information about children's cognitive-communication abilities in real-world contexts. Further research is needed to validate these assessments and to determine in which settings and situations they may prove most effective. Supplemental Material https://doi.org/10.23641/asha.15079026
... Researchers have discovered that school staff [37][38][39][40][41][42] and medical providers [43][44][45][46] have varying knowledge or efficacy when it comes to student concussion management. Therefore, a concerted statewide, department of education endorsed effort to train school staff on aspects of Return to Learn concussion management would be beneficial. ...
Article
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... These items may have required the learner to apply novel information in novel ways to make decisions for students in these vignettes. Research has shown that teachers lack training regarding traumatic brain injury, specifically knowledge of student services and other supports required by students recovering from mTBI (Davies & Ray, 2014;Ettel et al., 2016). The competency of Individual Recovery covers return-to learn strategies with focus on adamic adjustments and related student specific supports. ...
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Full-text available
Background It is essential to increase the knowledge base of teachers involved in facilitating return to learning in middle school students following a concussion. However, the best method to enhance the transfer of learning for teachers remains to be elucidated. Application of Adult Learning Theory (ALT) is a plausible solution to this problem. Purpose The purpose of this randomized post-test study was to examine the effects of ALT on the transfer of learning in teachers who work with individuals with concussion. Methods A convenience sample of 169 teachers at four middle schools were randomized to receive an in-service regarding concussion management either in ALT or traditional lecture format. Vignettes approximating classroom practice evaluated learning transfer. Results one-way between subjects ANOVA revealed no significant difference between the methods of educational delivery on group assessment scores (p = .22). Additionally, a regression analysis did not identify any demographic variables that predicted learning transfer (p = .65). A statistically significant difference existed for four questions (1, 4, 7, 25) between the groups (p = .03, .02, .01, .00, respectively). These vignettes were those that assessed information that was likely novel to the learner. Discussion The current study demonstrated that ALT applied to teacher in-service did not impact transfer of learning immediately post training compared to a traditional lecture format. Future research should continue to examine the effects of various educational strategies to enhance learning transfer for teachers managing students in the classroom after concussion.
... Educators have also inaccurately reported the belief that a previous mild TBI would not affect a student's current academic performance (Hawley, Ward, Magnay, & Mychalkiw, 2004) and that academic ability afterward was primarily related to effort (Linden, Braiden, & Miller, 2013). However, increases in educators' knowledge and confidence about TBI diagnosis and management have been associated with previous experience working with a child with TBI (Farmer & Johnson-Gerard, 1997;Linden et al., 2013) or completion of training in special education (Ettel, Glang, Todis, & Davies, 2016). Therefore, a proactive approach of providing all educators with strategies to facilitate the transition to school and to address the individualized needs of students after TBI is recommended (Bowen, 2005;Linden et al., 2013;Lumba-Brown et al., 2018). ...
Article
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Teachers play an important role in facilitating a student’s return to school after a concussion. Currently, there is limited evidence on teachers’ experiences and their role in managing concussions in the classroom. This study investigated teachers’ perceived knowledge and confidence regarding concussion recognition and management. A cross-sectional design was used for this online survey of secondary school teachers in the United States. Practicing teachers self-reported being moderately knowledgeable and confident in their knowledge of concussion signs and symptoms. Whereas teachers were moderately knowledgeable and confident in their knowledge of academic support strategies after a student’s concussion, teachers were minimally knowledgeable and confident in their knowledge of the criteria for the student’s return to school and activity. Personal history of concussion and participation in formal concussion education were associated with increases in teachers’ perceived knowledge and confidence regarding concussion and its management process. Overall, teachers believed it was important to learn about concussions to support a student’s return to school. Therefore, integration of concussion education into preservice teacher education programs and in-service trainings is recommended. Providing teachers with practical resources on academic adjustments can enhance the support provided to symptomatic students, reduce misconceptions about concussion, and facilitate dialogue among stakeholders involved in the management of concussions.
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BACKGROUND To inform prevention strategies, this study provides incidence, factors, and actions taken when a suspected concussion occurred in K-12 schools in Utah. METHODS Data were collected using Utah's Student Injury Reporting System (SIRS) from the academic years 2011-2012 to 2018-2019. SIRS is a unique online system that tracks injuries that occur in the school setting among K-12 students in Utah. Descriptive statistics were computed to characterize students with a suspected concussion. Chi-square (χ²) analysis looking at characteristics by school level was also conducted. RESULTS Over 63,000 K-12 students in Utah sustained an injury at school during the study period. Suspected concussions comprised 10% of all injuries. The prevalence of concussions was highest among males (60.6%) and elementary school students (42.6%) and most often occurred outdoors (57.6%) or on a playground/playfield (33.9%), and in sports- and recreation-related activities (75.1%) (specifically contact sports, 24.0%). Most students with a suspected concussion were absent 1 day or less from school (71.4%) but about 68% were seen by a medical professional. Further, there were differences by school level. Females and students playing contact sports had a higher percentage of suspected concussions as school level increased, whereas males and concussions sustained during school hours had a lower percentage of suspected concussions as school level increased. CONCLUSIONS SIRS enables schools in Utah to identify groups at risk for concussion, as well as activities most commonly associated with these injuries, within the school environment. Using this information, schools may implement targeted prevention strategies to protect students.
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Traumatic brain injury (TBI) affects children’s ability to succeed at school. Few educators have the necessary training and knowledge needed to adequately monitor and treat students with a TBI, despite schools regularly serving as the long-term service provider. In this article, we describe a return to school model used in Oregon that implements best practices indicated by the extant literature, as well as our research protocol for evaluating this model. We discuss project aims and our planned procedures, including the measures used, our quasi-experimental design using matched controls, statistical power, and impact analyses. This project will provide the evidential base for implementation of a return to school model at scale.
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Research on stakeholders in mild traumatic brain injury (mTBI) management in the schools has shown that several school personnel (e.g., nurses, athletic trainers, principals, speech-language pathologists) all contribute unique knowledge to a school-based mTBI management team. Special educators (SPEs) may be another stakeholder group that could provide additional knowledge and expertise in working with children in the schools following mTBI. We examined SPEs knowledge and perceptions of ability to support students with mTBI through an online survey. Results suggested that SPEs may provide unique, valuable knowledge that warrants their involvement on an mTBI management team. Similar to other school personnel, data from SPEs revealed specific areas of knowledge, as well as specific areas where knowledge was lacking. With additional focused continuing education and more clearly defined roles, SPEs may be an integral member of mTBI management teams.
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Long-term follow-up studies conducted during the K–12 school years suggest that challenges related to childhood traumatic brain injury (TBI) tend to persist or worsen over time. A 1999 survey of State Directors of Special Education revealed that most states had emerging initiatives for children with TBI and were expanding their capacity to serve this growing population. To determine whether significant changes in patterns of identification and service delivery had occurred, State Directors and brain injury consumer organizations were surveyed. Survey results show some improvement, but significant gaps remain. Most state education administrators perceive a gap between incidence of childhood TBI and identification of students with TBI to receive special education services. Recommendations for policy changes and research are provided.
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Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning. Pediatrics 2013;132:948-957.
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This study examined the effects of teacher self-efficacy, education, and years of experience on observed classroom practices across 2 dimensions—teacher support for student learning and time in academics—as they related to fifth-grade students' (n = 1,043) literacy skills. To address these issues, the study used longitudinal data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development. Teacher self-efficacy is assessed on a survey that indicates the extent to which teachers believe they can make a difference in their students' achievement. Structural equation modeling results indicated that teachers with a higher sense of self-efficacy showed more support and provided a more positive classroom environment than did teachers with lower self-efficacy; in addition, their students had stronger literacy skills. Teachers with greater self-efficacy and more years of experience spent less time in academics.
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To identify promising practices in educational service delivery. Consensus-building process with a multidisciplinary group of researchers, policy makers, and state Department of Education personnel. This white paper presents the group's consensus on the essential components of a statewide educational infrastructure to support students with traumatic brain injury across the spectrum of injury severity: (a) identification, screening, and assessment practices; (b) systematic communication between medical and educational systems; (c) tracking of child's progress over time; and (d) professional development for school personnel. The white paper also presents key outcomes for measuring success and provides recommendations both for policy change and for furthering research in childhood brain injury.
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School-based speech-language pathologists from 10 states responded to a survey concerning their readiness to provide services to students with traumatic brain injuries (TBIs). Survey responses provided a means of exploring speech-language pathologists' knowledge of TBI and facilitated recognition of accurate and inaccurate conceptions held by school-based speech-language pathologists concerning the characteristics and behaviors, criteria for identification and verification, and procedures for the assessment, treatment, and reintegration of students with TBI. Findings indicated that training had a positive effect on speech-language pathologists' knowledge of assessment, treatment, and overall management of students with TBI; however, a large percentage of school-based speech-language pathologists remain uncertain about providing services to students with TBI even after receiving specific TBI training. Furthermore, school-based speech-language pathologists continue to hold many misconceptions concerning TBI and its consequences.
Article
The researchers performed a survey study to determine the effectiveness of collegiate programmes in dispelling common misconceptions about traumatic brain injury (TBI) while preparing undergraduate and graduate students for special education (SpEd) careers. Respondents included 136 undergraduate and 147 graduate SpEd students in their final semesters before obtaining degrees. Each completed an 18‐item true/false survey about TBI and the associated recovery process. Results were compared with survey responses from 318 lay public respondents who participated in a previous study. Two major findings emerged: (a) no significant differences existed in misconception endorsement between SpEd students completing Bachelor's versus Master's degrees; and (b) graduating students in SpEd teacher preparation programmes endorsed similar misconceptions as lay public respondents; hence, these programmes do not appear effective in dispelling common TBI misconceptions. Improving academic preparation for special educators regarding TBI is imperative for effectively identifying, assessing and serving student survivors.
Article
This study was conducted to assess the perceptions of school psychologists regarding myths and misconceptions pertaining to traumatic brain injury (TBI). A sample of 304 school psychologists in the state of North Carolina was surveyed on 11 common myths and misconceptions about TBI. Results indicated that this group performed significantly better than the lay public on 6 of the items, although rates of endorsement were quite high on items related to injury mechanisms and recovery. Education, years of practice, previous training in TBI, and age had little effect on these findings. These findings support the need for additional training for school psychologists on TBI issues, and raise concerns about how students with TBI are being managed in the classroom setting.